How much rates vary
Facilitymedian $16,218 · 10th to 90th $813 to $16,596Professionalmedian $151 · 10th to 90th $117 to $224
Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.
Rates by insurance carrier
| Insurance Carrier | Facility/Professional | Modifier | Typical Low | Median | Typical High |
|---|---|---|---|---|---|
Aetna Setting Professional Modifier None Typical Low $123.03 Median $144.54 Typical High $204.17 | Professional | None | $123.03 | $144.54 | $204.17 |
Anthem BCBS Setting Facility Modifier None Typical Low $12,589.25 Median $16,218.10 Typical High $16,982.44 | Facility | None | $12,589.25 | $16,218.10 | $16,982.44 |
Anthem BCBS Setting Professional Modifier None Typical Low $114.82 Median $147.91 Typical High $223.87 | Professional | None | $114.82 | $147.91 | $223.87 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $72.44 Median $93.33 Typical High $141.25 | Professional | 62 · Two surgeons | $72.44 | $93.33 | $141.25 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $18.62 Median $23.99 Typical High $36.31 | Professional | 80 · Assistant surgeon | $18.62 | $23.99 | $36.31 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $16.22 Median $19.95 Typical High $31.62 | Professional | AS · PA/NP assist | $16.22 | $19.95 | $31.62 |
Cigna Setting Facility Modifier None Typical Low $691.83 Median $707.95 Typical High $2,290.87 | Facility | None | $691.83 | $707.95 | $2,290.87 |
Cigna Setting Professional Modifier None Typical Low $154.88 Median $173.78 Typical High $257.04 | Professional | None | $154.88 | $173.78 | $257.04 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $776.25 Median $812.83 Typical High $1,202.26 | Facility | None | $776.25 | $812.83 | $1,202.26 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $120.23 Median $154.88 Typical High $218.78 | Professional | None | $120.23 | $154.88 | $218.78 |
Martin's Point Setting Professional Modifier None Typical Low $123.03 Median $144.54 Typical High $204.17 | Professional | None | $123.03 | $144.54 | $204.17 |
United Setting Facility Modifier None Typical Low $776.25 Median $812.83 Typical High $1,202.26 | Facility | None | $776.25 | $812.83 | $1,202.26 |
United Setting Professional Modifier None Typical Low $117.49 Median $165.96 Typical High $229.09 | Professional | None | $117.49 | $165.96 | $229.09 |
10 more rates with less common billing modifiers
A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.
| Insurance Carrier | Facility/Professional | Modifier | Typical Low | Median | Typical High |
|---|---|---|---|---|---|
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $61.66 Median $72.44 Typical High $72.44 | Professional | 52 · Reduced service | $61.66 | $72.44 | $72.44 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $24.55 Median $28.84 Typical High $28.84 | Professional | 53 · Discontinued | $24.55 | $28.84 | $28.84 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $91.20 Median $107.15 Typical High $107.15 | Professional | 54 · Surgery only | $91.20 | $107.15 | $107.15 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $18.62 Median $21.88 Typical High $21.88 | Professional | 55 · Aftercare only | $18.62 | $21.88 | $21.88 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $12.30 Median $14.45 Typical High $14.45 | Professional | 56 · Pre-op care only | $12.30 | $14.45 | $14.45 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $69.18 Median $72.44 Typical High $72.44 | Professional | 52 · Reduced service | $69.18 | $72.44 | $72.44 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $27.54 Median $28.84 Typical High $28.84 | Professional | 53 · Discontinued | $27.54 | $28.84 | $28.84 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $102.33 Median $107.15 Typical High $107.15 | Professional | 54 · Surgery only | $102.33 | $107.15 | $107.15 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $20.42 Median $21.88 Typical High $21.88 | Professional | 55 · Aftercare only | $20.42 | $21.88 | $21.88 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $13.80 Median $14.45 Typical High $14.45 | Professional | 56 · Pre-op care only | $13.80 | $14.45 | $14.45 |
Where Maine sits
The same service costs 44.0 times more in Maine than in Montana. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.
Physician feeFacility fee
ME $16,369MT $372
Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.